Provider Demographics
NPI:1366828972
Name:THE LODGE AT MT PLEASANT LLC
Entity Type:Organization
Organization Name:THE LODGE AT MT PLEASANT LLC
Other - Org Name:THE LODGE ASSISTED LIVING & MEMORY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEELA
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGAPERUMAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-575-9896
Mailing Address - Street 1:1880 W 16TH ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-2180
Mailing Address - Country:US
Mailing Address - Phone:903-575-9896
Mailing Address - Fax:903-575-9064
Practice Address - Street 1:1880 W 16TH ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-2180
Practice Address - Country:US
Practice Address - Phone:903-575-9896
Practice Address - Fax:903-575-9064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-05
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
310400000X, 3104A0625X
TX1420963104A0630X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances